Disorders of Water Homeostasis in Neurosurgical Patients

Context: Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery. Setting: We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies. Patients: The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation. Interventions: We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism. Main Outcome Measures: Morbidity and mortality associated with deranged salt and water balance were measured. Results: The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach. Conclusions: A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients. (J Clin Endocrinol Metab 97: 1423-1433, 2012)